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205 Alcoholism and Hepatitis > Viral Hepatitis > Flashcards

Viral Hepatitis Flashcards

1
Q

Which viral hepatitis types have an oral faecal route of transmission?

A

A and E

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2
Q

Which types of viral hepatitis travel via IV?

A

Hep B and Hep C

Also Hep D in the presence of B

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3
Q

How long does the pre-icteric phase of acute hepatitis last and what signs are there?

A

1-2 weeks:

Flu-like, Anorexia, Fatigue, Malaise, N+V, Fever, Muscle pain, Headache.

Increased ALT/AST

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4
Q

How long does the icteric phase of acute hepatitis last? and what signs are associated with it?

A

2-4 weeks:

Jaundice, pale stools, dark urine, abdominal pain, itch, arthralgia and skin rash

Increased ALT/AST

Increased Bilirubin in blood

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5
Q

Which types of viral hepatitis can cause Chronic Hepatitis?

A

HBV and HCV

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6
Q

Define Chronic Persistent Hepatitis

A

Benign inflammatory condition of the liver, with limited fibrosis and no necrosis

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7
Q

Name three features of Chronic Persistent Hepatitis

A

Often asymptomatic

Hepatomegaly

ONLY AST raised, other LFTs normal

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8
Q

What investigations would you do for suspected Chronic Persistent Hepatitis? and what would it show?

A

Liver biopsy → some fibrosis but no necrosis

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9
Q

If the liver biopsy shows progressive inflammation, with necrosis of hepatocytes → cirrhosis (degeneration of cells, fibrous thickening of liver tissue), what does this suggest?

A

Chronic Active Hepatitis

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10
Q

What cancer does Chronic Active Hepatitis increase the risk of?

A

Hepatocellular Carcinoma

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11
Q

What would the liver function tests show for Chronic Active Hepatitis?

A

Increased AST and ALT

With other LFTs derangement with progression

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12
Q

What are the signs for Hepatic Failure?

A

Severe impairment of liver function

Jaundice, Coagulopathy, Hypoalbuminaemia, Encephalopathy, Multiorgan failure

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13
Q

What type of hepatitis does HAV cause? And what is its route of transmission?

A

Faecal Oral

Acute hepatitis

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14
Q

What are diagnostic markers for Hepatitis A?

A

Anti HAV-IgM - acute infection

Anti HAV-IgG - prior infection

As IgM acts first, and IgG is for long term immunity

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15
Q

How is Hepatitis B transmitted?

A

Sex or Blood (IV drugs, tattoos/piercings, transfusions)

Also transmitted vertically (childbirth) in developing countries.

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16
Q

What type of hepatitis does Hepatitis B cause? Acute or chronic?

A

Acute, but can lead to chronic if not cleared (both persistent and active possible)

17
Q

How are the features of Hep A and Hep B similar?

A

They both may be sub-clinical, but may have an acute pre-icteric phase (1-2 weeks) followed by a icteric phase (2-4 weeks)

18
Q

How is Hep B diagnosed?

A

HBV serology - Antigens → current infection

Antigens: HBsAg - Hep B surface antigen

HBeAg - envelope antigen/HBcAg - core antigen

Antibodies - immunity (vaccination or recent infection)

AntiHB IgG - past infection

AntiHBe - body in control: as antivirals react to HBeAg with AntiHBe

19
Q

What are the treatment indications for HBV?

A

Chronic >6 months

Viral load >2000iu/ml

Evidence of on-going liver disease

20
Q

What is the first line treatment for HBV?

A

PET: Peginterferon, Entecavir, Tenofovir

Second line: Lamivudine, Adefovir, Telbivudine

21
Q

What virus is only infective with co-existing hep B? And how does it affect hep B progression?

A

Hep D

It worsens hep B progression → cirrhosis/hepatocellular carcinoma (chronic active infection)

22
Q

How is hep C transmitted?

A

Blood

23
Q

What is Hep C more likely to cause? Acute hepatitis or chronic hepatitis?

A

Chronic

24
Q

How would hep C chronic phase manifestation appear on LFTs?

A

Deranged ALT/AST raised more than ALP/GGT

25
Q

How does HCV present chronically?

A

Chronic Mild symptoms (75%)

Liver failure (25%), of which 10% hepatocellular carcinoma

26
Q

How is Hep C diagnosed?

A

Hep C Antibody

Polymerase Chain Reaction - Hep C RNA PCR

Liver biopsy

27
Q

What is the medical treatment of HCV?

A

Peginterferon

RIbavarin

Direct Antivirals

Vaccination carries risks such as demyelination → MS type problem

28
Q

What is the commonest acute viral hepatitis? and how is it transmitted?

A

Hep E

Enterically (oral faecal)

29
Q

What are the clinical features of hep E?

A

Prolonged cholestasis - bile cannot flow into duodenum → jaundice

Malaise, anorexia, N+V

Abdominal pain, Hepatomegaly

Fever

30
Q

What is the most common non-viral infective hepatitis.

A

Malaria

31
Q

How would clotting time be affected by liver disease?

A

prolonged as liver not producing clotting factors

32
Q

Which hepatic virus is a risk for pregnant women?

A

HEV

33
Q

Which types of hepatic viruses can you vaccinate against?

A

Hep A, B, E

205 Alcoholism and Hepatitis (4 decks)

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